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Jake DaBell Dental Boise, PLLC

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Company Details

Name: Jake DaBell Dental Boise, PLLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Active-Existing
Date of registration: 24 Mar 2022 (3 years ago)
Financial Date End: 31 Mar 2026
Entity Number: 4672017
Place of Formation: IDAHO
File Number: 813311
ZIP code: 83704
County: Ada County
Principal Address: 9502 W FAIRVIEW AVE BOISE, ID 83704
Mailing Address: 9502 W FAIRVIEW AVE BOISE, ID 83704-8103

Member

Name Role Address Appointed On Resigned On
Timothy Paventy Member 624 3RD ST. SOUTH, NAMPA, ID 83651 2023-07-03 2024-03-13
Jake DaBell DDS Member 2715 S. BARKER ROAD, GREENACRES, WA 99016 2022-04-21 2023-07-03

Agent

Name Role Address
Luke Jacobsen Agent 9502 W FAIRVIEW AVE, BOISE, ID 83704

Manager

Name Role Address Appointed On
Luke Jacobsen Manager 9502 W FAIRVIEW AVE, BOISE, ID 83704 2025-03-03

National Provider Identifier

NPI Number:
1255055661
Certification Date:
2022-12-19

Authorized Person:

Name:
STEPHANIE FRANK
Role:
INSURANCE COORDINATOR
Phone:

Taxonomy:

Selected Taxonomy:
261QD0000X - Dental Clinic/Center
Is Primary:
Yes

Contacts:

Filing

Filing Name Filing Number Filing date
Annual Report 0006138058 2025-03-03
Amendment to Certificate 0005936194 2024-10-10
Change of Registered Office/Agent/Both (by Entity) 0005917435 2024-10-02
Change of Registered Office/Agent/Both (by Entity) 0005917442 2024-10-02
Annual Report 0005646411 2024-03-13

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Date of last update: 24 Jul 2025

Sources: Idaho Secretary of State